Heart Health: Why Rehabilitation Matters

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“When people care, it means so much.”

That’s how Rosina Lacalamita sums up her experience with West Park Healthcare Centre’s Cardiac Rehabilitation Service. Lacalamita has rheumatic heart disease, and recently underwent surgery to replace her mitral valve. She started in the new rehabilitation service in early September.

“It’s been really great,” she says. “I’m amazed to see how much my blood pressure has gone down with exercise. And the education is really super in helping you understand, cope and accept. I can’t praise the program enough.”

Cardiac rehabilitation helps people who have had heart attacks or heart surgery, and those who have some form of heart disease, return to good physical and mental health. Through a combination of counselling, education, behaviour modification and exercise, patients learn how to help themselves. There is growing evidence that cardiac rehabilitation results in lower mortality rates and reduces the incidence of further heart attacks, hospitalization and intervention procedures. Despite these results, only 15 per cent of heart attack survivors currently participate in cardiac rehabilitation programs.

The Cardiac Care Network (CCN) of Ontario predicts that 100,000 patients will need cardiac rehabilitation by the year 2002, far more than the current system can handle. In a report published in June 1999, the CCN called for the development of an expanded cardiac rehabilitation network throughout Ontario. West Park Healthcare Centre, located in the Jane Street and Weston Road neighbourhood, stepped in to fill the gap in northwest Toronto. The West Park service, one of eight pilot project sites across Ontario funded by the Ministry of Health and Long-Term Care, officially got underway in July 2001.

Dr. Roger Goldstein, an internationally renowned respirologist and medical director of the new service, says cardiac rehab fits with West Park’s specialized rehabilitation focus. “We have amputee, neurology, musculoskeletal and respiratory rehab services here, so it made sense to add value where we already have the expertise and infrastructure.”

Care at West Park is provided through individualized programs involving medical leadership, multi-disciplinary attention, clinical evaluation, education, counselling, behaviour modification, and prescribed exercise. Patients attend two sessions of exercise and education each week for six months. Admission requires a physician referral. Patients can get these from local family doctors, heart specialists or Community Care Access Centres. West Park is also working closely with the Heart and Stroke Foundation of Ontario, which has supplied patient education materials and advised on promotion of the program.

The care team is making a special effort to reach out to groups that have traditionally been under-serviced, especially those for whom English is not a first language. An interesting fact about heart disease is that it appears to hit those of Southeast Asian ancestry more than other groups. Research has identified that heart disease occurs in these individuals about 10-15 years earlier than in the west, tends to affect professionals more than those from a rural background and that the disease occurs more frequently even among those who have emigrated.

Dr. Mike Sarin, the internist treating patients in the West Park program, understands their concerns. Born in Jallandhar City, Punjab, Dr. Sarin is a graduate of Amritsar Medical College and completed his postgraduate education in the United Kingdom, receiving membership of Royal Colleges of Edinburgh and London. He then spent a year in Coorg State, South India with a US foreign aid program, establishing a rural hospital base. Dr. Sarin has practiced medicine in Canada since 1970. He is an Associate Professor at the University of Toronto and was chief of general internal medicine at the former Wellesley Hospital for 10 years before coming to West Park.

Dr. Sarin says research has revealed a startling picture for all cardiac patients who don’t participate in rehabilitation therapy. Within six years:

18% of men and 34% of women will have another heart attack

7% of men and 6% of women will experience sudden death

22% of men and 46% of women will be disabled with heart failure

8% of men and 11% of women will have a stroke

“That’s why it’s important that the public understands the need for treatment,” he says. “It’s a relatively simple but effective therapy.”